Abstract
BackgroundThe extent of bowel resection is widely debated in colon cancer surgery. Right hemicolectomy (RHC) and partial colectomy (PC) are the most common operation options for right-sided colon cancer (RCC). However, there are still no treatment guidelines or published studies to guide surgical options for mucinous adenocarcinoma (MAC) of RCC.MethodsPatients with MAC and non-specific adenocarcinoma (AC) of RCC who underwent RHC and PC from 2010 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. The general characteristics and survival were compared and analyzed.ResultsA total of 27,910 RCC patients were enrolled in this study, among them 3,413 were MAC. The results showed that race, carcinoembryonic antigen (CEA) level, perineural invasion (PNI), tumor size, tumor location, TNM stage, liver metastasis, chemotherapy were significantly different between MAC and AC groups. The MAC group had similar dissected lymph nodes, but more positive lymph nodes than the AC group. The overall survival (OS) of the MAC group was poorer than that of the AC group, but cancer-specific survival (CSS) was similar between the two groups. The RHC subgroup of the MAC group had more patients of age ≤60 years, larger tumor size, cecum/ascending colon location and dissected lymph nodes than the PC subgroup, but similar positive lymph nodes, perioperative mortality, OS and CSS as the PC subgroup. Moreover, the univariate and multivariable analyses for the survival of RCC patients with MAC showed that RHC might not be a superior predictor for OS and CSS compared with PC.ConclusionsRHC could not dissect more positive lymph nodes or provide long-term survival benefits for RCC patients with MAC compared with PC. This study could provide some evidence for surgery treatment selection for MAC of RCC, which has important clinical value in individual management of colon cancer patients.
Highlights
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death in the world [1]
The study included Right-sided colon cancer (RCC) patients according to the following criteria: 1) treatment with surgical resection, surgical types including Right hemicolectomy (RHC) or partial colectomy (PC); 2) the primary tumor sites were categorized as cecum, ascending colon, hepatic flexure, and transverse colon; 3) the patients had positive histology, and the morphology ICD-0–3 codes of Mucinous adenocarcinoma (MAC) were limited to mucinous adenocarcinoma (8,480/3), the control AC group codes were limited to adenocarcinoma NOS (8,140/3); and 4) exact and complete follow-up information was included
The results showed that the MAC group had a higher proportion of white patients, elevated CEA level, tumor size over 5 cm, tumor location at the cecum, positive lymph nodes, liver metastases, postoperative chemotherapy, and advanced TNM stage than the AC group (P < 0.05)
Summary
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death in the world [1]. Mucinous adenocarcinoma (MAC) is the second most common histopathological type of CRC, which more often occurs in the RCC [1, 2, 5]. Right hemicolectomy (RHC) and partial colectomy (PC) are the most common operation options for RCC [10, 11]. The main difference among the surgery options is the range of bowel resection, and all of them would perform adequate lymph node dissection for RCC treatment. The extent of bowel resection is widely debated in colon cancer surgery. Right hemicolectomy (RHC) and partial colectomy (PC) are the most common operation options for right-sided colon cancer (RCC). There are still no treatment guidelines or published studies to guide surgical options for mucinous adenocarcinoma (MAC) of RCC
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